Provider Demographics
NPI:1215909833
Name:NORMAN C SUDDUTH MD PA
Entity type:Organization
Organization Name:NORMAN C SUDDUTH MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SUDDUTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-548-3639
Mailing Address - Street 1:PO BOX 63069
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406
Mailing Address - Country:US
Mailing Address - Phone:305-229-4311
Mailing Address - Fax:305-229-4388
Practice Address - Street 1:5301 S CONGRESS AVE
Practice Address - Street 2:JFK MEDICAL CENTER
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462
Practice Address - Country:US
Practice Address - Phone:561-548-3639
Practice Address - Fax:561-548-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL99893OtherBLUE CROSS BLUE SHIELD
FL99893OtherBLUE CROSS BLUE SHIELD